Long-term follow-up of patients with deferred coronary intervention guided by measurement of fractional flow reserve

Introduction and Aims: The functional significance of coronary lesions can be assessed in the cardiac catheterization laboratory by determination of fractional flow reserve (FFR), thus overcoming one of the major limitations of conventional angiography. The aim of this study was to analyze the long-term clinical course of patients with intermediate coronary stenosis (50---70%) deferred for intervention based on FFR <0.80. Methods: Between May 1999 and December 2009, 300 lesions in 231 patients (mean age 65±10 years, 68% male and 75.3% with multivessel disease) were studied by FFR. Intervention was deferred in 282 (94%) lesions and 18 were treated based on FFR <0.80. We assessed the occurrence of major adverse cardiovascular events (MACE), defined as cardiovascular death, non-fatal acute coronary syndrome and target lesion revascularization (TLR). Results: During a median follow-up of 637 days (interquartile range 455---1160), there were 15 (6.5%) MACE in the subgroup of patients with target lesion intervention deferred based on FFR: one cardiovascular death, four hospitalizations for acute coronary syndrome and 14 TLR (12 patients were treated percutaneously and two underwent coronary artery bypass grafting). MACE-free survival at one year follow-up was 97.8%. Conclusion: These results, in a real-world population, support the current trend to base the decision to treat on functional rather than purely anatomical criteria, in order to improve safety and efficiency.

A polineuropatia amiloidótica familiar tipo-I (PAF tipo-I) é um tipo raro de amiloidose hereditária e sistémica causada pela mutação Val30Met no gene da transtirretina (TTR). O início das manifestações e o espectro clínico podem ser variáveis e dependem da heterogeneidade fenotípica. As complicações cardíacas (disritmias e perturbac¸ões da conduc¸ão, miocardiopatia e disautonomia) ditam um prognóstico mais reservado, mesmo após transplante hepático. É descrito um caso clínico atípico de PAF tipo-I com ênfase no grave envolvimento cardíaco e nas suas complicac¸ões. O diagnóstico precoce de cardiopatia amiloidótica tem assumido relevância no âmbito de vários ensaios clínicos com fármacos experimentais promissores.